近年來孩童過敏性疾病之盛行率逐年增加，且過去研究顯示，室內各種生物氣膠的暴露是影響孩童疾病/症狀表現的重要因子，常見的生物氣膠包含細菌、真菌及各式過敏原等，其中「個別」之生物性因子與孩童健康之關係已有豐富的文獻資料，然而，在實際生活環境中，這些生物性因子皆為共同存在的，其共同對於孩童疾病/症狀表現之影響仍是目前不清楚的。因此本研究欲利用病例-對照之研究設計，比較下列已在過去研究中被認為與健康有關之微生物因子，包括空氣中活性真菌、細菌、真菌孢子、粉塵(1→3)-β-D-Glucan、細菌內毒素以及室塵蟎過敏原Der p 1，來探討多重生物性污染物的暴露下，與孩童呼吸道疾病之間的關係，並嘗試釐清何種因子對於孩童健康的貢獻最為顯著。
分析結果顯示，室內真菌孢子 (fungal spores)濃度的高低與孩童睡覺時呼吸道症狀的表現有關 (9049.69 spores/m3 vs. 5965.37 spores/m3, p=0.01)；此外，醫師診斷過敏性症狀/疾病嚴重度較高之孩童（診斷總分大於5），其家中室內外活性真菌比值(fungal I/O)大小顯著高於嚴重度低者(1.20 vs. 0.83, p=0.04)。進一步的以多重因子迴歸分析探討各生物性污染物的共同暴露下與各症狀表現之關係：邏輯式迴歸分析結果發現，家中fungal I/O較高者，具有顯著較高的「醫師診斷過敏性症狀/疾病嚴重度（診斷總分大於5）」之風險 (OR=3.24)，且較高之真菌孢子濃度暴露亦會增加孩童睡覺時呼吸道症狀表現之風險 (OR=7.17)。除此之外，較高塵蟎過敏原 (Der p1)濃度的暴露，會增加孩童具較高total IgE (>91 kU/L) (OR=1.43)以及過敏性鼻炎症狀表現之風險 (OR=1.40)；線性迴歸結果發現，相較於其他生物性指標，塵蟎過敏原 (Der p1)之濃度分布與孩童呼吸道和過敏性症狀表現較有顯著之關係。本研究進一步瞭解住家環境指標與健康有關之生物性因子之相關性，希望藉由其他替代性的簡易指標來反應實際環境生物性因子濃度高低的表現。結果發現，房間內牆面的相對濕度大於100%、室內外24小時平均溫度分別小於27.13℃ 和27.58℃、室內24小時平均相對濕度大於63.65%、感覺家中有刺激性氣味及房間內人口密度較高，皆與特定之微生物因子，如塵蟎過敏原、室內真菌孢子之濃度分佈有關。另外，室內24小時平均相對濕度大於63.65%時，真菌glucan和細菌內毒素濃度顯著較高。
本研究透過實際家戶環境的調查以及孩童健康的追蹤記錄來評估各種生物性危害因子共同的影響，發現空氣中真菌孢子、室內外活性真菌比值以及塵蟎過敏原之暴露，相較於其他生物性因子，對於孩童健康表現的影響較為顯著；且室內牆面相對濕度、室內外溫度濕度等相關環境評估因子，可作為生物性因子濃度分布之替代性參考指標，進而反應室內孩童可能具有的健康風險，以作為未來在環境控制及衛生管理上的參考依據。

Literatures have consistently demonstrated associations between exposures to microbial agents in built environments with increasing risk of reporting respiratory diseases, mostly based on measurements of single or selected microbial agents. However, in reality, environmental microbes (e.g. fungi and bacteria and other allergens) are co-existed in any environments at all times. Therefore, study including concurrent assessment of related bioaerosols becomes essential to elucidate their individual or synergistic roles deriving at corresponding health outcomes of concerns. The aims of this study with children aged 6 to 8 is to investigate the individual and combined effects of concurrent exposures to various microbial agents, such as airborne fungal spores, viable fungi, viable bacteria, house dust associated fungal (1→3)-β-D-glucan and bacterial endotoxin, as well as house dust mite allergens, on reporting respiratory or allergic symptoms and diseases. Home characteristics are also analyzed for associations with quantitative microbial levels when appropriate to examine the potential and effective surrogates reflecting microbial exposures for prevention. Results indicate that fungal spores and Der p1 are the significant major microbial agents related to the studied health outcomes. Moreover, the moisture content of building materials (>100%), indoor and outdoor 24-hrs average temperature (<27.13℃ and <27.58℃, respectively), indoor 24-hrs average relative humidity (>63.65%), presence of irritant smells as well as higher human density can be considered as alternative or surrogate environmental indicators without actual maneuver of real sampling and analytical activity for environmental microbes. Preventive measures and priority of remedial actions can therefore be planned accordingly.

ACGIH. 1999. Bioaerosols: Assessment and Control.
ACGIH. 1986. Guidelines for assessment of bioaerosols in the indoor environment. Cincinnati, Ohio.
ACGIH. 1989. Guidelines for assessment of bioaerosols in the indoor environment. Cincinnati, Ohio.
Adhikari A, Jung J, Reponen T, Lewis JS, DeGrasse EC, Grimsley LF, et al. 2009. Aerosolization of fungi, (1-->3)-[beta]-d glucan, and endotoxin from flood-affected materials collected in New Orleans homes. Environ Res 109(3): 215-224.
AIHA. 1996. Field guide for the determination of biological contaminants in environmental samples. American Industrial Hygiene Association.
Allmers H, Huber H, Baur X. 2000. Two year follow-up of a garbage collector with allergic bronchopulmonary aspergillosis (ABPA). Am J Ind Med 37(4): 438-442.
Alwis KU, Milton DK, Alwis KU, Milton DK. 2006. Recombinant factor C assay for measuring endotoxin in house dust: comparison with LAL, and (1 --> 3)-beta-D-glucans. Am J Ind Med 49(4): 296-300.
anonymous. 1850. The British Museum reading room. Nature 2(199).
Arbes Jr SJ, Gergen PJ, Elliott L, Zeldin DC. 2005. Prevalences of positive skin test responses to 10 common allergens in the US population: Results from the Third National Health and Nutrition Examination Survey. Journal of Allergy and Clinical Immunology 116(2): 377-383.
Asher MI, Montefort S, Bjorksten B, Lai CKW, Strachan DP, Weiland SK, et al. 2006. Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC Phases One and Three repeat multicountry cross-sectional surveys. The Lancet 368(9537): 733-743.
B. Fahlbusch, L Jager, J. Heinrich, I Gro, H. E. Wichmann, K. Richter. 1999. Allergens in house-dust samples in Germany: results of an East-West German comparison. . Allergy 54(11): 1215-1222.
Baker JC, Ayres JG. 2000. Diet and asthma. Respiratory Medicine 94(10): 925-934.
Bakirci N, Kalaca S, Francis H, Fletcher AM, Pickering CA, Tumerdem N, et al. 2007. Natural history and risk factors of early respiratory responses to exposure to cotton dust in newly exposed workers. J Occup Environ Med 49(8): 853-861.
Bischof W, Koch A, Gehring U, Fahlbusch B, Wichmann HE, Heinrich J. 2002. Predictors of High Endotoxin Concentrations in the Settled Dust of German Homes. Indoor Air 12: 2-9.
Blanc PD, Eisner MD, Katz PP, Yen IH, Archea C, Earnest G, et al. 2005. Impact of the home indoor environment on adult asthma and rhinitis. J Occup Environ Med 47(4): 362-372.
Bornehag CG, Blomquist G, Gyntelberg F, rvholm B, Malmberg P, Nordvall L, et al. 2001. Dampness in Buildings and Health: Nordic Interdisciplinary Review of the Scientific Evidence on Associations between Exposure to Dampness in Buildings and Health Effects (NORDDAMP). Indoor Air 11: 72-86.
Bornehag CG, Sundell J, Bonini S, Custovic A, Malmberg P, Skerfving S, et al. 2004. Dampness in buildings as a risk factor for health effects, EUROEXPO: a multidisciplinary review of the literature (19982000) on dampness and mite exposure in buildings and health effects. Indoor Air 14: 243-257.
Braun-Fahrlander C, Gassner M, Grize L, Takken-Sahli K, Neu U, Stricker T, et al. 2004. No further increase in asthma, hay fever and atopic sensitisation in adolescents living in Switzerland. Eur Respir J 23(3): 407-413.
Braun-Fahrlander C, Riedler J, Herz U, Eder W, Waser M, Grize L, et al. 2002. Environmental Exposure to Endotoxin and Its Relation to Asthma in School-Age Children. N Engl J Med 347(12): 869-877.
Bruinen de Bruin Y, Koistinen K, Kephalopoulos S, Geiss O, Tirendi S, Kotzias D, et al. 2008. Characterisation of urban inhalation exposures to benzene, formaldehyde and acetaldehyde in the European Union: comparison of measured and modelled exposure data. Environ Sci Pollut Res Int 15(5): 417-430.
Bunger J, Antlauf-Lammers M, Schulz TG, Westphal GA, Muller MM, Ruhnau P, et al. 2000. Health complaints and immunological markers of exposure to bioaerosols among biowaste collectors and compost workers. Occup Environ Med 57(7): 458-464.
Burge H. 1995. Bioaerosols. 108.
Burge H. 1990. Bioaerosols: prevalence and health effects in the indoor environment. J Allergy Clin Immunol 86(5): 687-701.
Busse PJ, Wang JJ, Halm EA, Busse PJ, Wang JJ, Halm EA. 2005. Allergen sensitization evaluation and allergen avoidance education in an inner-city adult cohort with persistent asthma. J Allergy Clin Immunol 116(1): 146-152.
C.-G. Bornehag, J. Sundell, T. Sigsgaard. 2004. Dampness in buildings and health (DBH): Report from an ongoing epidemiological investigation on the association between indoor environmental factors and health effects among children in Sweden. Indoor Air 14(s7): 59-66.
C. G. Bornehag, J. Sundell, L. Hagerhed, S. Janson. 2003. Pet-keeping in early childhood and airway, nose and skin symptoms later in life. Allergy 58(9): 939-944.
Calder PC, Krauss-Etschmann S, de Jong EC, Dupont C, Frick J-S, Frokiaer H, et al. 2006. Early nutrition and immunity ? progress and perspectives. Br J Nutr 96(04): 774-790.
Carter PM, Peterson EL, Ownby DR, Zoratti EM, Johnson CC, Carter PM, et al. 2003. Relationship of house-dust mite allergen exposure in children's bedrooms in infancy to bronchial hyperresponsiveness and asthma diagnosis by age 6 to 7.[see comment]. Ann Allergy Asthma Immunol 90(1): 41-44.
Chang CW, Chung H, Huang CF, Su HJ. 2001. Exposure assessment to airborne endotoxin, dust, ammonia, hydrogen sulfide and carbon dioxide in open style swine houses. Ann Occup Hyg 45(6): 457-465.
Charpin D, Birnbaum J, Haddi E, Genard G, Lanteaume A, Toumi M, et al. 1991. Altitude and allergy to house-dust mites. A paradigm of the influence of environmental exposure on allergic sensitization. Am Rev Respir Dis 143(5 Pt 1): 983-986.
Chattopadhyay BP, Das S, Adhikari A, Alam J, Chattopadhyay BP, Das S, et al. 2007. Exposure to varying concentration of fungal spores in grain storage godowns and its effect on the respiratory function status among the workers. Ind Health 45(3): 449-461.
Chen L. 2003. Pyrogene - a new endotoxin detection method using recombinant Factor C. Presented for the 5th International Symposium on Future of Rural Peoples: Rural economy, Healthy people, Environment, Rural communities (Exposure to Endotoxin and Lung), Saskatoon, Saskatchewan, Canada, Oct 19 - 23.
Chinn S, Rona RJ. 2001. Can the increase in body mass index explain the rising trend in asthma in children? Thorax 56(11): 845-850.
Cole Johnson C, Ownby DR, Havstad SL, Peterson EL, Cole Johnson C, Ownby DR, et al. 2004. Family history, dust mite exposure in early childhood, and risk for pediatric atopy and asthma. J Allergy Clin Immunol 114(1): 105-110.
Courtois F, Seidman EG, Delvin E, Asselin C, Bernotti S, Ledoux M, et al. 2003. Membrane peroxidation by lipopolysaccharide and iron-ascorbate adversely affects Caco-2 cell function: beneficial role of butyric acid. Am J Clin Nutr 77(3): 744-750.
Cox CS, Wathes CM. 1995. Bioaerosols Handbook. Boca Raton, FL: CRC Press
ISBN 1-87371-615-9: 621 pages.
Cullinan P, MacNeill SJ, Harris JM, Moffat S, White C, Mills P, et al. 2004. Early allergen exposure, skin prick responses, and atopic wheeze at age 5 in English children: a cohort study. Thorax 59(10): 855-861.
Custovic A, Simpson BM, Simpson A, Hallam CL, Marolia H, Walsh D, et al. 2003. Current mite, cat, and dog allergen exposure, pet ownership, and sensitization to inhalant allergens in adults. J Allergy Clin Immunol 111(2): 402-407.
Dassonville C, Demattei C, Detaint B, Barral S, Bex-Capelle V, Momas I, et al. 2008. Assessment and predictors determination of indoor airborne fungal concentrations in Paris newborn babies' homes. Environ Res 108(1): 80-85.
de Palo VA, de Palo VA. 2004. Pulmonary disease: pneumonia, chronic obstructive pulmonary disease, asthma, and thromboembolic disease. J Am Podiatr Med Assoc 94(2): 157-167.
Delfino RJ, Zeiger RS, Seltzer JM, Street DH, Matteucci RM, Anderson PR, et al. 1997. The effect of outdoor fungal spore concentrations on daily asthma severity. Environ Health Perspect 105(6): 622-635.
Donham KJ, Cumro D, Reynolds SJ, Merchant JA. 2000. Dose-Response Relationships Between Occupational Aerosol Exposures and Cross-Shift Declines of Lung Function in Poultry Workers:: Recommendations for Exposure Limits. Journal of Occupational and Environmental Medicine 42(3): 260-269.
Douwes J, Doekes G, Montijn R, Heederik D, Brunekreef B. 1996. Measurement of beta(1-->3)-glucans in occupational and home environments with an inhibition enzyme immunoassay. Appl Environ Microbiol 62(9): 3176-3182.
Douwes J, Thorne P, Pearce N, Heederik D. 2003a. Bioaerosol health effects and exposure assessment: progress and prospects. Ann Occup Hyg 47(3): 187-200.
Douwes J, Thorne P, Pearce N, Heederik D. 2003b. Bioaerosol Health Effects and Exposure Assessment: Progress and Prospects. Ann Occup Hyg 47(3): 187-200.
Douwes J, van Strien R, Doekes G, Smit J, Kerkhof M, Gerritsen J, et al. 2006. Does early indoor microbial exposure reduce the risk of asthma? The Prevention and Incidence of Asthma and Mite Allergy birth cohort study. J Allergy Clin Immunol 117(5): 1067-1073.
Douwes J, Zuidhof A, Doekes G, van der Zee SC, Wouters I, Boezen MH, et al. 2000. (1-->3)-beta-D-glucan and endotoxin in house dust and peak flow variability in children. Am J Respir Crit Care Med 162(4 Pt 1): 1348-1354.
Eder W, Ege MJ, von Mutius E. 2006. The Asthma Epidemic. N Engl J Med 355(21): 2226-2235.
Ellwood P, Asher MI, Bjorksten B, Burr M, Pearce N, Robertson CF. 2001. Diet and asthma, allergic rhinoconjunctivitis and atopic eczema symptom prevalence: an ecological analysis of the International Study of Asthma and Allergies in Childhood (ISAAC) data. Eur Respir J 17(3): 436-443.
Eugenia LH, Leonard BB. 2005. The Atopic March: The Pattern of Allergic Disease Development in Childhood. Immunology and allergy clinics of North America 25(2): 231-246.
Falth-Magnusson K, Kjellman NI. 1992. Allergy prevention by maternal elimination diet during late pregnancy--a 5-year follow-up of a randomized study. J Allergy Clin Immunol 89(3): 709-713.
Fiegel J, Clarke R, Edwards DA, Fiegel J, Clarke R, Edwards DA. 2006. Airborne infectious disease and the suppression of pulmonary bioaerosols. Drug Discov Today 11(1-2): 51-57.
Fisk WJ, Lei-Gomez Q, Mendell MJ. 2007. Meta-analyses of the associations of respiratory health effects with dampness and mold in homes. Indoor Air 17(4): 284-296.
Foto M, Plett J, Berghout J, Miller JD, Foto M, Plett J, et al. 2004. Modification of the Limulus amebocyte lysate assay for the analysis of glucan in indoor environments. Anal Bioanal Chem 379(1): 156-162.
Fung F, Hughson WG, Fung F, Hughson WG. 2003. Health effects of indoor fungal bioaerosol exposure. Appl Occup Environ Hyg 18(7): 535-544.
Gao L, Tsai YJ, Grigoryev DN, Barnes KC, Gao L, Tsai YJ, et al. 2007. Host defense genes in asthma and sepsis and the role of the environment. Curr Opin Allergy Clin Immunol 7(6): 459-467.
Garrett MH, Rayment PR, Hooper MA, Abramson MJ, Hooper BM. 1998. Indoor airborne fungal spores, house dampness and associations with environmental factors and respiratory health in children. Clinical & Experimental Allergy 28(4): 459-467.
Gehring U, Heinrich J, Hoek G, Giovannangelo M, Nordling E, Bellander T, et al. 2007. Bacteria and mould components in house dust and children's allergic sensitisation. Eur Respir J 29(6): 1144-1153.
Gell PGH, Coombs RRA. 1963. Clinical Aspects of Immunology. 1st ed. Oxford, England: Blackwell.
Giovannangelo M, Nordling E, Gehring U, Oldenwening M, Bellander T, Heinrich J, et al. 2007. Variation of biocontaminant levels within and between homes--the AIRALLERG study. J Expo Sci Environ Epidemiol 17(2): 134-140.
Giovannangelo MECA, Gehring U, Nordling E, Oldenwening M, van Rijswijk K, de Wind S, et al. 2007. Levels and determinants of beta(1-->3)-glucans and fungal extracellular polysaccharides in house dust of (pre-)school children in three European countries. Environ Int 33(1): 9-16.
Grad R. 2000. Risk of asthma in children with exposure to mite and cat allergens. The Lancet 356(9239): 1369-1370.
Hauswirth DW, Sundy JS, Hauswirth DW, Sundy JS. 2004. Bioaerosols and innate immune responses in airway diseases. Curr Opin Allergy Clin Immunol 4(5): 361-366.
Hedayati MT, Mayahi S, Aghili R, Goharimoghadam K, Hedayati MT, Mayahi S, et al. 2005. Airborne fungi in indoor and outdoor of asthmatic patients' home, living in the city of sari. Iran 4(4): 189-191.
Heida H, Bartman F, SC vdZ. 1995. Occupational exposure and indoor air quality monitoring in composting facility. Am Ind Hyg Assoc J 56(1):39-43.
Heldal KK, Halstensen AS, Thorn J, Eduard W, Halstensen TS. 2003. Airway inflammation in waste handlers exposed to bioaerosols assessed by induced sputum. Eur Respir J 21(4): 641-645.
Heyes J, Siebers R, Parkes A, Pierse N, Crane J, Heyes J, et al. 2009. Beta-(1,3)-glucan levels and its determinants in New Zealand bedrooms. J Asthma 46(1): 64-66.
Hollander A, Heederik D, Kauffman H. 1994. Acute respiratory effects in the potato processing industry due to a bioaerosol exposure. Occup Environ Med 51(2): 73-78.
Iossifova Y, Reponen T, Sucharew H, Succop P, Vesper S. 2008. Use of (1-3)-beta-d-glucan concentrations in dust as a surrogate method for estimating specific fungal exposures. Indoor Air 18(3): 225-232.
Iossifova YY, Reponen T, Bernstein DI, Levin L, Kalra H, Campo P, et al. 2007a. House dust (1-3)-beta-D-glucan and wheezing in infants. Allergy 62(5): 504-513.
Iossifova YY, Reponen T, Bernstein DI, Levin L, Kalra H, Campo P, et al. 2007b. House dust (1-3)-beta-D-glucan and wheezing in infants. Allergy 62(5): 504-513.
J. K. PEAT, W. J. BRITTON, C. M. SALOME, A. J. WOOLCOCK. 1987. Bronchial hyperresponsiveness in two populations of Australian schoolchildren. III. Effect of exposure to environmental allergens. Clin Exp Allergy 17(4): 291-300.
Janeway C, Travers P, Walport M, Shlomchik M. 2001. Immunobiology; Fifth Edition. New York and London: Garland Science pp. e-book. ISBN 0-8153-4101-6.
Janssen NA, Brunekreef B, van Vliet P, Aarts F, Meliefste K, Harssema H, et al. 2003. The relationship between air pollution from heavy traffic and allergic sensitization, bronchial hyperresponsiveness, and respiratory symptoms in Dutch schoolchildren. Environ Health Perspect 111(12): 1512-1518.
Jovanovic S, Felder-Kennel A, Gabrio T, Kouros B, Link B, Maisner V, et al. 2004. Indoor fungi levels in homes of children with and without allergy history. Int J Hyg Environ Health 207(4): 369-378.
Kalogerakis N, Paschali D, Lekaditis V, Pantidou A, Eleftheriadis K, Lazaridis M. 2005. Indoor air quality--bioaerosol measurements in domestic and office premises. Journal of Aerosol Science 36(5-6): 751-761.
Karadag B, Ege MJ, Scheynius A, Waser M, Schram-Bijkerk D, van Hage M, et al. 2007. Environmental determinants of atopic eczema phenotypes in relation to asthma and atopic sensitization. Allergy 62(12): 1387-1393.
Kedzierska A. 2007. (1 --> 3)-beta-D-glucan--a new marker for the early serodiagnosis of deep-seated fungal infections in humans. Pol J Microbiol 56(1): 3-9.
Kim JL, Elfman L, Mi Y, Wieslander G, Smedje G, Norback D. 2007. Indoor molds, bacteria, microbial volatile organic compounds and plasticizers in schools--associations with asthma and respiratory symptoms in pupils. Indoor Air 17(2): 153-163.
Koenig JQ, Mar TF, Allen RW, Jansen K, Lumley T, Sullivan JH, et al. 2005. Pulmonary effects of indoor- and outdoor-generated particles in children with asthma.[see comment]. Environ Health Perspect 113(4): 499-503.
Koppelman GH, te Meerman GJ, Postma DS. 2008. Genetic testing for asthma. Eur Respir J 32(3): 775-782.
Kovesi T, Creery D, Gilbert NL, Dales R, Fugler D, Thompson B, et al. 2006. Indoor air quality risk factors for severe lower respiratory tract infections in Inuit infants in Baffin Region, Nunavut: a pilot study. Indoor Air 16(4): 266-275.
L. C. Rodrigues, P. J. Newcombe, S. S. Cunha, N. M. Alcantara-Neves, B. Genser, A. A. Cruz, et al. 2008. Early infection with <i>Trichuris trichiura</i> and allergen skin test reactivity in later childhood. Clin Exp Allergy 38(11): 1769-1777.
Lane J, Siebers R, Pene G, Howden-Chapman P, Crane J. 2005. Tokelau: a unique low allergen environment at sea level. Clinical & Experimental Allergy 35: 479-482.
Larsson L. 1995. Incidence of asthma in Swedish teenagers: relation to sex and smoking habits. Thorax 50(3): 260-264.
Lau S, Illi S, Sommerfeld C, Niggemann B, Bergmann R, von Mutius E, et al. 2000. Early exposure to house-dust mite and cat allergens and development of childhood asthma: a cohort study. The Lancet 356(9239): 1392-1397.
Lau S, Wahn U. 2001. Allergen exposure and asthma. The Lancet 357(9261): 1042-1043.
Laumbach RJ, Kipen HM, Laumbach RJ, Kipen HM. 2005. Bioaerosols and sick building syndrome: particles, inflammation, and allergy. Curr Opin Allergy Clin Immunol 5(2): 135-139.
Lavoie J, Dunkerley CJ, Kosatsky T, Dufresne A, Lavoie J, Dunkerley CJ, et al. 2006. Exposure to aerosolized bacteria and fungi among collectors of commercial, mixed residential, recyclable and compostable waste. Sci Total Environ 370(1): 23-28.
Law M, Morris JK, Wald N, Luczynska C, Burney P. 2005. Changes in atopy over a quarter of a century, based on cross sectional data at three time periods. Bmj 330(7501): 1187-1188.
Liebers V, Raulf-Heimsoth M, Bruning T. 2008. Health effects due to endotoxin inhalation (review). Arch Toxicol 82(4): 203-210.
Liu AH. 2002. Endotoxin exposure in allergy and asthma: Reconciling a paradox. Journal of Allergy and Clinical Immunology 109(3): 379-392.
Liu LJ, Krahmer M, Fox A, Feigley CE, Featherstone A, Saraf A, et al. 2000. Investigation of the concentration of bacteria and their cell envelope components in indoor air in two elementary schools. J Air Waste Manag Assoc 50(11): 1957-1967.
M. B. Emanuel. 1988. Hay fever, a post industrial revolution epidemic: a history of its growth during the 19th century. Clinical & Experimental Allergy 18(3): 295-304.
Matheson MC, Abramson MJ, Dharmage SC, Forbes AB, Raven JM, Thien FCK, et al. 2005. Changes in indoor allergen and fungal levels predict changes in asthma activity among young adults. Clin Exp Allergy 35(7): 907-913.
Matthew Masoli, Denise Fabian, Shaun Holt, Richard Beasley. 2004. The global burden of asthma: executive summary of the GINA Dissemination Committee Report. Allergy 59(5): 469-478.
Maziak W, Behrens T, Brasky TM, Duhme H, Rzehak P, Weiland SK, et al. 2003. Are asthma and allergies in children and adolescents increasing? Results from ISAAC phase I and phase III surveys in Munster, Germany. Allergy 58: 572-579.
Michel O, Kips J, Duchateau J, Vertongen F, Robert L, Collet H, et al. 1996. Severity of asthma is related to endotoxin in house dust. Am J Respir Crit Care Med 154(6): 1641-1646.
Milton DK, Feldman HA, Neuberg DS, Bruckner RJ, Greaves IA. 1992. Environmental endotoxin measurement: the Kinetic Limulus Assay with Resistant-parallel-line Estimation. Environ Res 57(2): 212-230.
Milton DK, Johnson DK, Park JH. 1997. Environmental endotoxin measurement: interference and sources of variation in the Limulus assay of house dust. Am Ind Hyg Assoc J 58(12): 861-867.
Mudarri D, Fisk WJ. 2007. Public health and economic impact of dampness and mold.[erratum appears in Indoor Air. 2007 Aug;17(4):334]. Indoor Air 17(3): 226-235.
Neas LM, Dockery DW, Burge H, Koutrakis P, Speizer FE. 1996. Fungus spores, air pollutants, and other determinants of peak expiratory flow rate in children. Am J Epidemiol 143(8): 797-807.
Newhouse CP, Levetin E, Newhouse CP, Levetin E. 2004. Correlation of environmental factors with asthma and rhinitis symptoms in Tulsa, OK. Ann Allergy Asthma Immunol 92(3): 356-366.
Nicolai T, Carr D, Weiland SK, Duhme H, von Ehrenstein O, Wagner C, et al. 2003. Urban traffic and pollutant exposure related to respiratory outcomes and atopy in a large sample of children. Eur Respir J 21(6): 956-963.
Nicolaou N, Yiallouros P, Pipis S, Ioannou P, Simpson A, Custovic A, et al. 2006. Domestic allergen and endotoxin exposure and allergic sensitization in Cyprus. Pediatr Allergy Immunol 17(1): 17-21.
Nowak-Wegrzyn A, Wood RA. 1999. Association Between Der P 1 Concentration and Peak ExpiratoryFlow Rate in Children With Wheeze: A Longitudinal Analysis. Pediatrics 104(2): 382-.
O'Connor G T, Walter M, Mitchell H, Kattan M, Morgan WJ, Gruchalla RS, et al. 2004. Airborne fungi in the homes of children with asthma in low-income urban communities: The Inner-City Asthma Study. J Allergy Clin Immunol 114(3): 599-606.
Odabasi Z, Paetznick VL, Rodriguez JR, Chen E, McGinnis MR, Ostrosky-Zeichner L, et al. 2006. Differences in beta-glucan levels in culture supernatants of a variety of fungi. Med Mycol 44(3): 267-272.
Ownby DR, Johnson CC, Peterson EL. 2002. Exposure to Dogs and Cats in the First Year of Life and Risk of Allergic Sensitization at 6 to 7 Years of Age. JAMA 288(8): 963-972.
Park JH, Cox-Ganser J, Rao C, Kreiss K. 2006. Fungal and endotoxin measurements in dust associated with respiratory symptoms in a water-damaged office building. Indoor Air 16(3): 192-203.
Park JH, Cox-Ganser JM, Kreiss K, White SK, Rao CY, Park J-H, et al. 2008. Hydrophilic fungi and ergosterol associated with respiratory illness in a water-damaged building. Environ Health Perspect 116(1): 45-50.
Park JH, Gold DR, Spiegelman DL, Burge HA, Milton DK. 2001. House dust endotoxin and wheeze in the first year of life. Am J Respir Crit Care Med 163(2): 322-328.
Pasanen AL. 2001. A review: fungal exposure assessment in indoor environments. Indoor Air 11(2): 87-98.
Peterson RD, Wicklunds PE, Good RA. 1964. Endotoxin activity of a house dust extract. J Allergy Clin Immunol 35: 134-142.
Polk S, Sunyer J, Munoz-Ortiz L, Barnes M, Torrent M, Figueroa C, et al. 2004. A Prospective Study of Fel d1 and Der p1 Exposure in Infancy and Childhood Wheezing. Am J Respir Crit Care Med 170(3): 273-278.
Prester L, Brcic Karaconji I, Macan J, Prester L, Brcic Karaconji I, Macan J. 2007. Determination of mite allergens in house dust using the enzyme immunoassay. Arh Hig Rada Toksikol 58(4): 413-419.
Radon K. 2006. THE TWO SIDES OF THE "ENDOTOXIN COIN". Occup Environ Med 63(1): 73-78.
Remes ST, Iivanainen K, Koskela H, Pekkanen J. 2003. Which factors explain the lower prevalence of atopy amongst farmers' children?[see comment]. Clinical & Experimental Allergy 33(4): 427-434.
Rusca S, Charriere N, Droz PO, Oppliger A. 2008. Effects of bioaerosol exposure on work-related symptoms among Swiss sawmill workers. Int Arch Occup Environ Health 81(4): 415-421.
Rylander R. 1997. Investigations of the relationship betw een disease and airborne (1-->3)-beta-D-glucan in buildings. Mediators Inflamm 6(4): 275-277.
Rylander R, Michel O, Rylander R, Michel O. 2005. Organic dust induced inflammation--role of atopy and TLR-4 and CD14 gene polymorphisms. American Journal of Industrial Medicine 48(4): 302-307.
Rylander R, Rylander R. 2006. Endotoxin and occupational airway disease. Curr Opin Allergy Clin Immunol 6(1): 62-66.
S. F. Bloomfield, R. Stanwell-Smith, R. W. R. Crevel, J. Pickup. 2006. Too clean, or not too clean: the Hygiene Hypothesis and home hygiene. Clin Exp Allergy 36(4): 402-425.
Saijo Y, Yoshida T, Kishi R, Saijo Y, Yoshida T, Kishi R. 2009. [Dampness, biological factors and sick house syndrome]. Nippon Eiseigaku Zasshi 64(3): 665-671.
Schaumann F, Muller M, Braun A, Luettig B, Peden DB, Hohlfeld JM, et al. 2008. Endotoxin augments myeloid dendritic cell influx into the airways in patients with allergic asthma. Am J Respir Crit Care Med 177(12): 1307-1313.
Schernhammer ES, Vutuc C, Waldh, r T, Haidinger G. 2008. Time trends of the prevalence of asthma and allergic disease in Austrian children. Pediatric Allergy and Immunology 19: 125-131.
Schram-Bijkerk D, Doekes G, Douwes J, Boeve M, Riedler J, Ublagger E, et al. 2005. Bacterial and fungal agents in house dust and wheeze in children: the PARSIFAL study. Clinical & Experimental Allergy 35(10): 1272-1278.
Schram D, Doekes G, Boeve M, Douwes J, Riedler J, Ublagger E, et al. 2005. Bacterial and fungal components in house dust of farm children, Rudolf Steiner school children and reference children--the PARSIFAL Study. Allergy 60(5): 611-618.
Sebastian A, Pehrson C, Larsson L, Sebastian A, Pehrson C, Larsson L. 2006. Elevated concentrations of endotoxin in indoor air due to cigarette smoking. J Environ Monit 8(5): 519-522.
Seo S-C, Grinshpun SA, Iossifova Y, Schmechel D, Rao CY, Reponen T. 2007. A New Field-Compatible Methodology for the Collection and Analysis of Fungal Fragments. Aerosol Science and Technology 41(8): 794 - 803.
Siebers R, Parkes A, Crane J. 2006. Beta-(1,3)-glucan on pillows. Allergy 61(7): 901-902.
Siebers R, Parkes A, Miller JD, Crane J. 2007. Effect of allergen-impermeable covers on beta-(1,3)-glucan content of pillows. Allergy 62(4): 451-452.
Simpson A, Custovic A, Simpson A, Custovic A. 2004. Allergen avoidance in the primary prevention of asthma. Curr Opin Allergy Clin Immunol 4(1): 45-51.
Smit LA, Heederik D, Doekes G, Blom C, van Zweden I, Wouters IM, et al. 2008. Exposure-response analysis of allergy and respiratory symptoms in endotoxin-exposed adults. Eur Respir J 31(6): 1241-1248.
Spicer R, Gangloff H. 2005. Establishing site specific reference levels for fungi in outdoor air for building evaluation. J Occup Environ Hyg 2(5): 257-266.
Sporik R, Holgate S, Platts-Mills T, Cogswell J. 1990. Exposure to house-dust mite allergen (Der p I) and the development of asthma in childhood. A prospective study. N Engl J Med 323(8): 502-507.
Sporik R, Holgate ST, Platts-Mills TA, Cogswell JJ. 1990. Exposure to house-dust mite allergen (Der p I) and the development of asthma in childhood. A prospective study.[see comment]. New England Journal of Medicine 323(8): 502-507.
Stiehm ER, Ochs HD, Winkelstein JA. 2004. Immunologic disorders in infants & children. Fifth Edition. London: W B Saunders.
Strachan DP, Butland BK, Anderson HR. 1996. Incidence and prognosis of asthma and wheezing illness from early childhood to age 33 in a national British cohort.[see comment]. Bmj 312(7040): 1195-1199.
Su H-J, Wu P-C, Chen H-L, Lee F-C, Lin L-L. 2001. Exposure Assessment of Indoor Allergens, Endotoxin, and Airborne Fungi for Homes in Southern Taiwan. Environ Res 85(2): 135-144.
Su HJ, Chen HL, Huang CF, Lin CY, Li FC, Milton DK, et al. 2002. Airborne fungi and endotoxin concentrations in different areas within textile plants in Taiwan: a 3-year study. Environ Res 89(1): 58-65.
Szymanska J, Szymanska J. 2005. Exposure to bacterial endotoxin during conservative dental treatment. Ann Agric Environ Med 12(1): 137-139.
Takeda M, Saijo Y, Yuasa M, Kanazawa A, Araki A, Kishi R, et al. 2009. Relationship between sick building syndrome and indoor environmental factors in newly built Japanese dwellings. Int Arch Occup Environ Health 82(5): 583-593.
Tham KW, Zuraimi MS, Koh D, Chew FT, Ooi PL, Tham KW, et al. 2007. Associations between home dampness and presence of molds with asthma and allergic symptoms among young children in the tropics. Pediatr Allergy Immunol 18(5): 418-424.
Thorn J, Beijer L, Rylander R. 1998. Airways inflammation and glucan exposure among household waste collectors. American Journal of Industrial Medicine 33(5): 463-470.
Thorn J, Rylander R. 1998. Airways inflammation and glucan in a rowhouse area. Am J Respir Crit Care Med 157(6 Pt 1): 1798-1803.
Trivedi B, Valerio C, Slater JE, Trivedi B, Valerio C, Slater JE. 2003. Endotoxin content of standardized allergen vaccines. J Allergy Clin Immunol 111(4): 777-783.
Unlu M, Ergin C, Cirit M, Sahin U, Akkaya A, Unlu M, et al. 2003. Molds in the homes of asthmatic patients in Isparta, Turkey. Asian Pac J Allergy Immunol 21(1): 21-24.
van Vliet P, Knape M, de Hartog J, Janssen N, Harssema H, Brunekreef B. 1997. Motor Vehicle Exhaust and Chronic Respiratory Symptoms in Children Living near Freeways. Environmental Research 74(2): 122-132.
VENN AJ, LEWIS SA, COOPER M, HUBBARD R, BRITTON J. 2001. Living Near a Main Road and the Risk of Wheezing Illness in Children. Am J Respir Crit Care Med 164(12): 2177-2180.
von Hertzen LC, Haahtela T. 2004. Asthma and atopy - the price of affluence? Allergy 59: 124-137.
von Mutius. 1998. The rising trends in asthma and allergic disease. Clin Exp Allergy 28(s5): 45-49.
von Mutius E, Braun-Fahrlander C, Schierl R, Riedler J, Ehlermann S, Maisch S, et al. 2000. Exposure to endotoxin or other bacterial components might protect against the development of atopy. Clinical & Experimental Allergy 30(9): 1230-1234.
Wahn U, Lau S, Bergmann R, Kulig M, Forster J, Bergmann K, et al. 1997. Indoor allergen exposure is a risk factor for sensitization during the first three years of life. J Allergy Clin Immunol 99(6 Pt 1): 763-769.
Walters M, Milton D, Larsson L, Ford T. 1994. Airborne environmental endotoxin: a cross-validation of sampling and analysis techniques. Appl Environ Microbiol 60(3): 996-1005.
Wan GH, Li CS. 1999. Indoor endotoxin and glucan in association with airway inflammation and systemic symptoms. Arch Environ Health 54(3): 172-179.
Warrier MR, Hershey GK, Warrier MR, Hershey GKK. 2008. Asthma genetics: personalizing medicine. J Asthma 45(4): 257-264.
WHO. 2007. 10 facts on asthma.
WHO. 2002. Guidelines for concentration and exposure-response measurements of fine and ultra fine particulate matter for use in epidemiological studies. Geneva: World Health Organization.
WHO. 1990. Indoor air quality Biological contaminant. European Series No 31 Copenhagen: WHO Regional Publications.
Wills-Karp M, Santeliz J, Karp CL. 2001. The germless theory of allergic disease: revisiting the hygiene hypothesis. Nat Rev Immunol 1(1): 69-75.
Withers N, Low L, Holgate S, Clough J. 1998. The Natural History of Respiratory Symptoms in a Cohort of Adolescents. Am J Respir Crit Care Med 158(2): 352-357.
Wouters IM, Hilhorst SK, Kleppe P, Doekes G, Douwes J, Peretz C, et al. 2002. Upper airway inflammation and respiratory symptoms in domestic waste collectors.[erratum appears in Occup Environ Med 2002 Jul;59(7):497]. Occup Environ Med 59(2): 106-112.
Young S-H, Castranova V. 2005. Toxicology of (1-3)-beta-D-glucans. Glucans as a Marker for Fungal Exposure.
Yu H, Hanes M, Chrisp CE, Boucher JC, Deretic V. 1998. Microbial pathogenesis in cystic fibrosis: pulmonary clearance of mucoid Pseudomonas aeruginosa and inflammation in a mouse model of repeated respiratory challenge. Infect Immun 66(1): 280-288.
Yuguo Li. 2007. Indoor Air and infection. Indoor Air 17(5): 335-336.
Zhou X, Shi W, Zhang Q, Wang X, Zhou X, Shi W, et al. 2008. Experimental study on role of endotoxin in induction of murine model of allergic asthma. Wei Sheng Yen Chiu 37(4): 397-404.
Zock JP, Brunekreef B, Hazebroek-Kampschreur AA, Roosjen CW. 1994. House dust mite allergen in bedroom floor dust and respiratory health of children with asthmatic symptoms. Eur Respir J 7(7): 1254-1259.